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Chlamydia trachomatis is one of the atypical pathogens, also a strict intracellular parasite with unique developmental cycle of prokaryotic microorganisms, resulting in infantile respiratory infections and conjunctivitis.Chlamydia trachomatis is associated with respiratory diseases such as chronic cough and bronchial asthma in children.Children infected with Chlamydia trachomatis generally have a good prognosis after treatment.At present, important progress has been made in the development of Chlamydia trachomatis vaccine.This article reviews the progress in etiology, epidemiology, clinical features, laboratory inspection, diagnosis, treatment and prevention of Chlamydia trachomatis, providing a new direction for clinical recognition and effective treatment of Chlamydia trachomatis infection.
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ObjectiveTo investigate the mechanism of Yiqi Huoxue Tongluo prescription （YHTP） in the treatment of diabetic neuropathic pain （DNP）. MethodNinety SPF-grade SD male rats were randomized into blank， model， low- （2.25 g·kg-1）， medium- （4.5 g·kg-1）， and high-dose （9 g·kg-1） YHTP， and mecobalamin （0.175 mg·kg-1） groups. Except those in the blank group， the rats in the remaining 5 groups were fed with a high-fat and high-glucose diet and subjected to intraperitoneal injection of low-dose （35 mg·kg-1） streptozotocin （STZ） to establish the model of DNP. The sciatic nerve conduction velocity in DNP rats was measured by the neurophysiological method， and the levels of interleukin-6 （IL-6）， IL-1β， and tumor necrosis factor-α （TNF-α） were measured by enzyme-linked immunosorbent assay （ELISA）. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was employed to measure the mRNA levels of glial fibrillary acidic protein （GFAP） and extracellular signal-regulated kinase （ERK） in the spinal cord. Western blot was employed to measure the protein levels of GFAP and phosphorylated ERK （p-ERK）， and immunofluorescence staining to measure the fluorescence intensity of GFAP and p-ERK in the spinal cord. In the cell experiments， 100 mmol·L-1 high glucose was used to induce the activation of astrocytes （CTX-TNA2） for the modeling of nerve cell injury. The cells were randomized into the normal， model， drug-containing serum （10% YQHT）， inhibitor ［10 mol·L-1 corynoxeine （COR）］， drug-containing serum + inhibitor （10% YHTP + 10 mol·L-1 COR） groups. The levels of pro-inflammatory factors （TNF-α and IL-1β） and the anti-inflammatory factor IL-10 in CTX-TNA2 cells were determined by ELISA， and the protein levels of GFAP and p-ERK in CTX-TNA2 cells by Western blot. ResultThe animal experiments showed that compared with the blank group， the model group presented reduced mechanical withdrawal threshold （MWT）， thermal work limit （TWL）， and nerve conduction velocity， elevated levels of fasting blood glucose， IL-1β， TNF-α， and IL-6， and up-regulated protein levels of GFAP and p-ERK， and mRNA levels of ERK1， ERK2， GFAP （P<0.01）. Compared with model group， YHTP increased the MWT， TWL， and sciatic nerve conduction velocity （P<0.01）， lowered the levels of IL-1β， TNF-α， and IL-6 （P<0.01）， and down-regulated the protein levels of GFAP and p-ERK， and mRNA levels of ERK1， ERK2， GFAP in the spinal cord （P<0.05， P<0.01）. The cell experiments showed that compared with the blank group， the model group had decreased survival rate， elevated levels of pro-inflammatory factors， and up-regulated protein levels of ERK and GFAP （P<0.01）. Compared with the model group， the YHTP-containing serum lowered the levels of IL-1β and TNF-α （P<0.05， P<0.01）， elevated the level of IL-10 （P<0.01）， and down-regulated the protein levels of ERK and GFAP （P<0.01）. ConclusionYHTP may inhibit the activation of astrocytes by inhibiting the ERK signaling pathway to reduce inflammation and thus relieve DNP.
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Objective:To explore the driving mechanisms of doctors′ collaborative willingness and behavior in the tiered diagnosis and treatment system, in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods:Based on the harmonious management theory, a theoretical framework for the driving mechanisms of doctors′ collaborative behavior in the tiered diagnosis and treatment system was developed. Through random sampling, a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022. The t-test, variance analysis, and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics. The structural equation model and stratified linear regression were used to assess the impact of collaborative factors (professional environment and work expectations) and harmonious factors (perception of policy support and perception of management mechanism) on doctors′ collaboration willingness and behavior. Results:A total of 1 959 doctors participated in the survey. Doctors′ collaborative behavior scored 2.13±1.12, indicating a slightly below-average level, whereas their willingness to collaborate scored 3.88±0.79, falling between neutral and somewhat willing. Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking, age, years of experience, monthly average income, and professional titles ( P<0.05). Both collaborative and harmonious factors directly influenced the doctors′ willingness to collaborate, with standardized path coefficients of 0.428 and 0.139, respectively. Similarly, these factors directly impacted their collaborative behavior, with standardized path coefficients of 0.104 and 0.366. The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′ collaborative willingness and behavior, with effect values of 0.047 and 0.043 respectively ( P<0.05). Conclusions:The collaborative and harmonious elements serve as positive drivers for collaboration among doctors in the tiered diagnosis and treatment system at both the cognitive and behavioral levels. Enhancing and optimizing policy support and management mechanisms can facilitate the transition from intention to actual collaborative actions among doctors from different levels of medical institutions.
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Objective:This study aims to explore the possible development path of hospital research assistants in China based on the cognition of the demand and management status quo from research management personnel in tertiary hospitals.Methods:62 scientific research management personnel from all over the country were surveyed, data about their cognition and the current status of scientific research assistants, that including the willingness of employ, position cognition, eligibility and competence, quantity and efficiency, management implementation, influencing factors and difficulties in team development, were collected and analyzed. Regarding to the practical needs and management status, the results were described by frequency, percentage and average score, and the rank sum test was used to verify whether there was any difference in the employment intention between the management department and the project team in the cognition of the survey subjects.Results:From the perspective of scientific research managers, there is a strong willingness at hospital level to employ the research assistant, positions require applicants with bachelor′s degree or above in medicine or other related majors. The most urgent needs are management of project funds, equipment and consumables, research integrity and ethics.The interviewees who work with research assistants think that the effect of research assistants on improving scientific research efficiency is obvious.However, the percentage of formulation of research assistants management measures is less than 40%, and the percentages of uniformly organized training and assessment are relatively low. There are still problems and challenges, such as incomplete cognition of the positioning and function, incomplete functional and vocational system, imperfect incentive mechanism and insufficient support for ability cultivation and improvement.Conclusions:It′s necessary to strengthen the top-down design of the development of scientific research assistant team and the construction of career system, improve the management basis and implementation mechanism, supporting resources should be in place, and promote capacity building system in order to develop a long-term mechanism of mutual promotion between the team building of scientific research assistants and the innovation of hospital scientific research management.
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Obstructive sleep apnea hypopnea syndrome(OSAHS) is one of the common diseases harmful to children′s health.OSAHS is a disease characterized by complete or partial obstruction of the upper respiratory tract, accompanied by blood gas changes and atypical sleep patterns.The incidence of OSAHS is on the rise.OSAHS can cause a series of physical, mental and developmental abnormalities in children, resulting in negative consequences for children.Common causes of OSAHS in children include mechanisms such as compliance changes caused by increased upper airway resistance and influence of neural regulation.Meanwhile, studies have shown that season、environmental factors have certain effects on the incidence and severity of OSAHS and sleep structure.This paper reviews the effects of season and environmental factors on children with OSAHS.
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Objective:To explore the risk factors of unplanned readmission in patients with acute myocardial infarction, and to construct a risk prediction model.Methods:This study used cross-sectional survey method. A total of 270 acute myocardial infarction patients admitted from Tianjin Union Medical Cencer from March 2020 to March 2021 were evaluated in a cardiology department. We used the electronic medical record system to collect the patients′ data. Patients were divided into two groups according to the occurrence of readmission within 1 year or not. Logistic regression analysis was performed to identify risk factors and formulated prediction model.Results:Totally 81 patients (30%) were readmitted. Binary Logistic regression model showed that the independent influencing factors of unplanned readmission in acute myocardial infarction patients included smoking ( X1), hypertension ( X2), marital status ( X3), hospitalization days ( X4), percutaneous coronary intervention ( X5), and heart failure ( X6). Area under ROC curve was 0.840, the maximum value of the Youden index was 0.560, and the sensitivity was 85.2%, the specificity was 70.8%, and the cutoff value was 0.377. Prediction model expression of unplanned readmission risk in patients with acute myocardial infarction was Logit(p/1-p)=-4.012+1.172 X1+1.104 X2+0.992 X3+0.118 X4+1.191 X5+1.093 X6. Conclusions:The risk prediction model of unplanned readmission in patients with acute myocardial infarction established in this article was with a good predictive effect, and it could be used in early identification of those patients with high-risk in unplanned readmission. At the same time, combined with the risk factors of depression, targeted intervention measures can be formulated.
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Objective:To discuss the development and management of full-time research assistants in China′s large hospitals.Methods:Through the methods of policy sorting, literature research, summarization, and classification, this study focused on the policy background, development opportunities, and the needs of the times for the position establishment of research assistants in China′s large hospitals, comprehensively classified the practical exploration and existing problems of employing and managing full-time research assistants in typical large hospitals in the country, and discussed the relevant management strategies learned from international experience.Results:In addition to hospitals directly affiliated with colleges and universities, dozens of large local hospitals in more than ten provinces have carried out beneficial practices of establishing the employment, management, and assessment systems for research assistants positions and achieved some progress. However, there are still common problems such as limited cognition of ″temporary positions″, insufficient coverage of the positions, low salary and welfare, and lack of training and development mechanisms as well as promotion and career development paths.Conclusions:The development and management of research assistants in large hospitals have gradually shifted their purpose from alleviating the employment issue of the graduates to reserving talented people in medical teaching, researching and managing, forming a high-quality, professional, and full-time medical scientific team, and continuously innovating. This article puts forward some suggestions about establishing the management system of research assistants, strengthening the standardized training for talented people, and constructing a diversified incentive mechanism combining performance appraisal and target management for research assistants.
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The top-level design and training system of standardized training for residents has been basically completed in China, and now is gradually transiting to connotation construction and quality improvement, with the emphasis on post competency and quality as the core. There are discrepancies in clinical ability among general practice residents of different categories, so the step-up training mode should be adapted for set up and implement of phased training objectives to achieve the overall goal of training qualified general practitioners. The step-up training based on the framework of entrustable professional activities(EPAs)can quantitatively and qualitatively evaluate the competency of general practice residents and continuously track it, so that to ensure the competency of residents. This study has developed assessment item pools of EPAs-based step-up training for general practice residents through literature review and focus group discussion, and proposed implementation plans, and explored the application of EPAs in the step-up training of general practice residents.
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Obstuctive sleep apnea-hypopnea syndrome(OSAHS) is a kind of disease that seriously endangers children′s health, which can disrupt children′s normal ventilation and sleep structure.Untreated OSAHS in children can cause damage to multiple systems, including cardiovascular, metabolic, endocrine and neurocognitive systems and even to death.Although polysomnography is the gold standard for the diagnosis of OSAHS in children, it is thought to be costly, labor-intensive, uncomfortable and the limitation of medical conditions in some areas, many patients can not obtain timely diagnosis.Therefore, it is necessary to find a simple and effective method for early screening of OSAHS in children.
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Objective:To investigate the vitamin D level of pulmonary tuberculosis patients in Qinghai Province, and to explore the correlation between vitamin D level and pulmonary tuberculosis.Methods:From May to September 2020, 208 bacterial confirmed pulmonary tuberculosis patients who were admitted to The 4th People′s Hospital of Qinghai Province were enrolled as the pulmonary tuberculosis group, and 129 healthy people who underwent physical examination during the same period were enrolled as the healthy control group. Independent sample t test and chi-square test were used for statistical analysis. Results:The deficiency rate of vitamin D was 11.06%(23/208) in the pulmonary tuberculosis group, which was higher than that (3.10%(4/129)) in the healthy control group, and the difference was statistically significant ( χ2=6.840, P=0.009). The vitamin D level was (56.84±20.03) μg/L in the pulmonary tuberculosis group, which was lower than that ((67.39±17.07) μg/L) in the healthy control group, and the difference was statistically significant ( t=5.154, P<0.01). The vitamin D levels were not different between the newly treated ((56.66±20.02) μg/L)) and retreated pulmonary tuberculosis patients ((59.11±20.81) μg/L) ( t=0.468, P=0.650). The vitamin D level of simple pulmonary tuberculosis patients ((57.82±20.01) μg/L) was higher than that of pulmonary tuberculosis patients combined with other diseases ((48.08±18.46) μg/L), and the difference was statistically significant ( t=2.132, P=0.034). Conclusion:Pulmonary tuberculosis is associated with decreased vitamin D levels, and patients with pulmonary tuberculosis are more likely to suffer from decreased or deficient vitamin D, which suggests clinicians considering the vitamin D status when treating pulmonary tuberculosis patients.
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Objective@#To understand the level and risk factor of lead exposure among children in one city of Jiangsu.@*Methods@#In northern Jiangsu Province, 373 children from 2 primary schools were enrolled and were tested for blood lead and heavy metal exposure. Lead exposure was tested in household dust of 46 children. A multivariate Logistic regression was used for lead exposure risk analysis. Spatial distribution of lead contamination in household dust was conducted and compared with the location of industrial enterprises.@*Results@#The geometric mean of blood lead in 373 children was 25.80 mg/L,the blood lead of 3 children (0.8%) was more than 100 mg/L. Pencil biting ( OR=4.26, 95%CI=1.61-10.68, P <0.05) and lead contamination in surrounding environment ( OR=2.93, 95%CI=1.24-7.34, P =0.02) was positively related to high blood lead level in children. The geometric mean household dust lead concentrations in 46 children was 302.27 μg/mg, and household with high dust lead levels were mainly located around manufacturing enterprises.@*Conclusion@#Environmental factors correlate with blood lead level in children. Efficient strategies and public health policies are urgently needed to control and prevent environmental lead pollution. Families and schools should actively carry out health education to engourage children good hygiene habits, and effectively reduce lead exposure.
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Objective:To explore the metabolic regulations of different Traditional Chinese Medicine (TCM) syndromes in the diabetic patients with high risk for foot ulceration.Methods:Based on gas chromatography-mass spectrometer and multi-dimensional data processing methods, the metabolomics analysis was used to compare the serum metabolites profile of healthy people (32 cases) and the high-risk foot patients in Cold and Blood Stagnation syndrome (44 cases), Heat-toxin hurting Yin syndrome (54 cases), and Qi-Blood deficiency syndrome (33 cases), who were hospitalized at Shanghai TCM-Integrated Hospital from Apirl to December, 2018.Results:This study suggested that compared with healthy people, the diabetic patients with high risk for foot ulceration showed significantly lower serum level of urea [(2.41 ± 1.57)×10 5vs. (3.32 ± 2.10)×10 5], L-leucine [(4.94 ± 3.15)×10 5vs. (6.39 ± 3.57)×10 5], aspartic acid [(3.94 ± 4.48)×10 5vs. (9.62 ± 6.93)×10 5], 9H-purine [(1.74 ± 1.95)×10 5vs. (3.34 ± 2.23)×10 5] ( P<0.05 or P<0.01), while higher level of d-Glucose [(3.72 ± 1.71)×10 5vs. (2.21 ± 1.32)×10 5] and d-glucopyranose [(3.32 ± 2.10)×10 5vs. (1.35 ± 1.43)×10 5] ( P<0.01). Energy metabolism, amino acid metabolism and sugar metabolism were mainly involved. the content of L-tyrosine in the group of patients with Cold and Blood Stagnation syndromewas significantly higher than that in healthy people. The urea, purine, leucine, aspartic acidcontent in patients of Heat-toxin hurting Yin syndrome were significantly lower than that in healthy people. The purine content in patients of Qi and Blood Deficiency Syndrome was significantly lower than that in healthy people. Compared with the syndrome of Heat-toxin hurting Yin syndrome, patients in Cold and Blood Stagnation syndrome showed a significantly higher content of beta-1-galactopyranoside and butanoic acid. Compared to the Qi-Blood deficiency syndrome, serum urea level in patients of Heat-toxin hurting Yin syndrome was significantly higher than those in the patients of other two TCM syndromes. Conclusions:The serum metabolomics profiling differentiate three TCM-syndrome in high-risk DF patients, which can provide objective basis for clinical TCM syndrome differentiation and treatment of high-risk diabetic foot patients.
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Obstructive sleep apnea hypopnea syndrome(OSAHS)is a serious health hazard in children.It can cause damage to multiple systems, including cardiovascular, metabolic, endocrine and neurocognitive systems, especially for cognitive impairment.OSAHS may cause sleep fragmentation and intermittent ventilation abnormalities due to repeated partial or total upper airway obstruction, resulting in hypoxemia and hypercarbia, affect attention, intelligence, memory, language, executive function, etc.
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【Objective】 To compare the transfusion effects of ABO homotype leukocyte depleted suspended RBC and washed RBC in patients, who present major and minor cross-match incompatibility, DAT+, IAT+ and autoantibody+ . 【Methods】 The hemoglobin and total bilirubin of patients before and after transfusion were detected, and statistical analysis was conducted by IBM SPSS Statistics 22.0 software. 【Results】 34 transfusions were performed in 17 patients with major and minor cross-match incompatibility. Both leukocyte depleted suspended RBC and washed RBC significantly increased Hb level(P0.05), with similar transfusion efficacy(P>0.05). After t, Hb levels(g/L) increased by 11.35±8.07 and 13.94±9.017, and TBIL(μmol/L) decreased by 25.76±88.63 and 6.91±9.39, respectively, after the transfusion of leukocyte depleted suspended RBC and washed RBC per unit. 【Conclusion】 For blood recipients with major and minor cross-match incompatibility, both ABO homotype leukocyte depleted suspended RBC and washed RBC, given in time, were effective. However, washed RBC is secondary choice due to long preparation time and short storage time.
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Objective:To investigate the clinical characteristics and risk factors of bronchiolitis obliterans (BO) after adenovirus pneumonia.Methods:Clinical data of 266 children with adenovirus pneumonia hospitalized in Children′s Hospital of Soochow University from January 2011 to December 2017 were retrospectively analyzed.Accor-ding to whether they developed BO, children with adenovirus pneumonia were divided into the BO group and the non-BO group.Clinical features of the BO group and the non-BO group were compared by t test, rank sum test or chi square test.Risk factors were analyzed by Logistic regression approach. Results:Among 266 children with adenovirus pneumonia included, 37 patients were developed into BO group, and their age was significantly younger than that of the non-BO group [12.0(8.0, 17.5) months vs.32.0(13.0, 48.0) months, P<0.001]. Compared with the non-BO group, there were more proportion of preterm infants[10.8%(4/37 cases) vs.3.1%(7/229 cases), P=0.028], more instances of comorbidities [21.6%(8/37 cases) vs.4.4%(10/229), P<0.001] and more children with allergic diseas[35.1%(13/37 cases) vs.20.1%(46/229 cases), P=0.041] in the BO group, and the difference was statistically significant.The duration of fever in the BO group was significantly longer than that of the non-BO group [10(4.0, 13.5) d vs.6(4.0, 9.0) d, P=0.011] children with symptoms of wheezing, shortness of breath, and hypoxemia in the BO group were significantly more than the non-BO group[81.1%(30/37 cases) vs.27.9%(64/229 cases), P<0.001; 64.9%(24/37 cases) vs.5.7%(13/229 cases), P<0.001; 59.5%(22/37 cases) vs.6.6%(15/229 cases), P<0.001]. The platelet count, IgG level, and CD3 -CD 19+ lymphocyte percentage were significantly higher in the BO group than the non-BO group [(364±104)×10 9/L vs.(297±105)×10 9/L, P=0.001; 6.74(4.92, 10.16) g/L vs.5.93(1.00, 8.04) g/L, P=0.016; (33.5±15.3)% vs.(26.1±10.2)%, P=0.008]. In contrast, the percentage of CD3 + CD4 + lymphocytes in the BO group was lower than the non-BO group[(29.1±8.0)% vs.(32.5±9.4)%, P=0.044], the difference was statistically significant.The BO group had a higher rate of mixed bacterial infection than the non-BO groups[37.8%(14/37 cases) vs.16.6%(38/229 cases), P=0.003]. An age<26 months, comorbidities, premature birth history, wheezing, shortness of breath, and hypoxemia were independent risk factors for BO after adenovirus pneumonia( OR=4.808, 30.667, 7.558, 3.909, 8.842, 8.607, all P<0.05). Conclusions:An age of less than 26 months, a history of premature delivery comorbidities, wheezing, shortness of breath and hypoxemia, are independent risk factors for BO after adenovirus pneumonia.Children with above manifestations should receive high resolution CT as soon as possible to determine whether it is BO.
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Stress-induced gastric mucosal lesion (SGML) is one of the most common visceral complications after trauma. Restraint water-immersion stress (RWIS) can induce gastric mucosal lesion within a few hours. It has been confirmed that hyperfunction of parasympathetic nervous system contributes to the gastric dysfunction induced by RWIS. The dorsal motor nucleus of vagus, nucleus of solitary tract, hypothalamic supraoptic nucleus, paraventricular nucleus, mediodorsal thalamic nucleus, central amygdaloid nucleus and medial prefrontal cortex are all involved in the formation of SGML. Neurotransmitter/neuromodulation such as substance P, acetylcholine, oxytocin may be involved in the physiological process. This article reviewed the nervous mechanism of gastric mucosal lesion induced by RWIS in rats.
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Objective@#To investigate the incidence of post-bronchiolitis recurrent wheezing and its risk factors in children.@*Methods@#This study was conducted on patients with bronchiolitis admitted to the Department of Respiratory Disease, Children′s Hospital of Soochow University between November 2016 and March 2017.Nasopharyngeal secretions were taken from all patients and assessed for respiratory pathogens.After discharge, the patients were followed up every 3 months by outpatient visit or telephone call for 1 year.@*Results@#Eighty-nine patients with bronchiolitis were enrolled in this study.Among those 89 patients, respiratory syncytial virus(RSV) infection accounted for 46.1%(41/89 cases), Mycoplasma pneumonia(MP) for 5.6%(5/89 cases), rhinovirus(RV) for 4.5%(4/89 cases), and human bocavirus(hBoV) for 2.2%(2/89 cases). Eighty-three patients were successfully followed up.At the 3, 6, 9, and 12 months of follow-up, the occurrence of wheezing episodes for only once happened in 20 cases(24.1%), 27 cases(32.5%), 35 cases (42.2%), and 38 cases(45.8%), respectively.At 12 months after initial bronchiolitis, the occurrence of wheezing episodes for only once happened in 21 cases(25.3%), 2 episodes of wheezing in 10 cases(12.0%), and 7 cases (8.4%) had more than 3 episodes of wheezing, and 6 cases lost follow-up.The proportion of eczema and milk-protein allergy in post-bronchiolitis recurrent wheezing group was significantly higher than that of the group with not post-bronchiolitis recurrent wheezing patients (χ2=6.219, 4.855, all P<0.05). Logistic regression analysis showed eczema was the independent risk factor for post-bronchiolitis recurrent wheezing(OR=0.189, 95%CI: 0.047-0.765). There were no significant difference in gender, age, premature birth, birth weight, feeding pa-tterns, family history of asthma, pet contact history, severity of disease, course of disease, total immunoglobulin E of serum and the species of virus infected between 2 groups(all P>0.05).@*Conclusions@#The incidence of recurrent wheezing among post-bronchiolitis patients is higher during one-year follow-up period.Eczema is the independent risk factor for post-bronchiolitis recurrent wheezing.The specific pathogens and severity of disease have no correlation with post-bronchiolitis wheezing.
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Objective To investigate the incidence of post-bronchiolitis recurrent wheezing and its risk factors in children.Methods This study was conducted on patients with bronchiolitis admitted to the Department of Respiratory Disease,Children's Hospital of Soochow University between November 2016 and March 2017.Nasopharyngeal secretions were taken from all patients and assessed for respiratory pathogens.After discharge,the patients were followed up every 3 months by outpatient visit or telephone call for 1 year.Results Eighty-nine patients with bronchiolitis were enrolled in this study.Among those 89 patients,respiratory syncytial virus(RSV) infection accounted for 46.1％ (41/89 cases),Mycoplasma pneumonia(MP) for 5.6％ (5/89 cases),rhinovirus (RV) for 4.5％ (4/89 cases),and human bocavirus(hBoV) for 2.2％ (2/89 cases).Eighty-three patients were successfully followed up.At the 3,6,9,and 12 months of follow-up,the occurrence of wheezing episodes for only once happened in 20 cases(24.1％),27 cases(32.5％),35 cases (42.2％),and 38 cases (45.8％),respectively.At 12 months after initial bronchiolitis,the occurrence of wheezing episodes for only once happened in 21 cases (25.3％),2 episodes of wheezing in 10 cases (12.0％),and 7 cases (8.4％) had more than 3 episodes of wheezing,and 6 cases lost follow-up.The proportion of eczema and milk-protein allergy in post-bronchiolitis recurrent wheezing group was significantly higher than that of the group with not post-bronchiolitis recurrent wheezing patients (x2 =6.219,4.855,all P ＜ 0.05).Logistic regression analysis showed eczema was the independent risk factor for post-bronchiolitis recurrent wheezing(OR =0.189,95％ CI:0.047-0.765).There were no significant difference in gender,age,premature birth,birth weight,feeding patterns,family history of asthma,pet contact history,severity of disease,course of disease,total immunoglobulin E of serum and the species of virus infected between 2 groups (all P ＞ 0.05).Conclusions The incidence of recurrent wheezing among post-bronchiolitis patients is higher during one-year follow-up period.Eczema is the independent risk factor for post-bronchiolitis recurrent wheezing.The specific pathogens and severity of disease have no correlation with post-bronchiolitis wheezing.
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Objective To analyze the changes in lung function and inflammatory indicators such as eosino-phils(EOS),Creola bodies and exhaled nitric oxide(FeNO),and to explore their value in early diagnosing asthma. Methods One hundred and thirty-five infants with high-risk asthma were selected as an observation group who were admitted to Department of Respiratory,Childrenˊs Hospital of Soochow University from April 2016 to August 2017 due to asthmatic bronchitis and asthmatic bronchopneumonia,and a total of 200 non -asthmatic and non -allergic healthy children who were screened and followed up at the Department of Cardiology in the same period were selected as a healthy control group for the measurement of moist respiratory lung function and FeNO. In the observation group,the bronchial dilation test(BDT),EOS and Creola bodies were performed simultaneously. Classification of lung function:23%≤time to peak ratio(TPTEF/Te)<28% had mild obstruction,15%≤TPTEF/Te<23% had moderate obstruc-tion,and TPTEF/Te<15% showed severe obstruction. Results The TPTEF/Te[17. 20%(8. 10%)],volume to peak ratio(VPEF/Ve)[21. 20%(6. 20%)],tidal volume per kilogram of body weight(VT/kg)[7. 80(3. 70)]and ratio of tidal expiratory flow 25% to peak tidal expiratory flow(25/PF)[0. 54(0. 20)]in the observation group were signifi-cantly lower than those in the healthy control group[22. 30%(9. 22%),27. 15%(7. 10%),8. 90(3. 17),0. 60 (0. 18)],and the differences were statistically significant(Z＝ -6. 81,-9. 35,-3. 16,-3. 52,all P<0. 05). BDT positive rate in the mild obstruction group was 20. 00%(3/15 cases),BDT positive rate in the moderate obstruction group was 26. 56%(17/64 cases),and BDT positive rate in the severe obstruction group was 48. 72%(19/39 cases). The higher the degree of obstruction,the higher the value of BDT positive diagnosis(F＝6. 353,P<0. 05). BDT of VPEF/Ve,25/PF and TPTEF/Te were consistent and statistically significant(Kappa＝0. 78,0. 49,all P<0. 001). Ti-dal expiratory flow 50% -remaining(TEF50% -r)[(117. 86 ± 42. 16)mL/s],tidal expiratory flow 25% -remai- ning(TEF25% -r)[(82. 82 ± 35. 44)mL/s]in the second wheezing group were higher than those in the first whee-zing group[(92. 81 ± 28. 40)mL/s,(65. 22 ± 24. 93)mL/s],and the differences were statistically significant( t＝3. 34,2. 77,all P <0. 05). There was no statistically significant difference in sputum EOS,FeNO and Creola body scores among wheezing children between the first and second groups(all P>0. 05). FeNO in the observation group [3. 80(5. 43)μg/L]was significantly lower than that in the healthy control group[9. 60(11. 3)μg/L],and the diffe-rence was statistically significant(Z＝14. 56,P<0. 05). Sputum EOS had a positive correlation with blood EOS and Creola bodies(r＝0. 20,0. 21,all P<0. 05);there was no correlation between lung function parameters and inflamma-tory indices(all P>0. 05). Conclusions In the acute phase of infant asthma attack,the pulmonary function presents different degrees of obstructive ventilation dysfunction,the higher the degree of obstruction,the higher the diagnostic value of BDT. The value of single FeNO measurement is limited,and continuous dynamic monitoring may be more mea-ningful in predicting the occurrence of asthma. Detection of Creola bodies may be helpful in predicting asthma.
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Objective@#To analyze the epidemiological characteristics of influenza virus type A (FluA) in children with respiratory tract infection, and to provide scientific basis for clinical diagnosis and treatment.@*Methods@#Sputum specimens of 35 529 cases of hospitalized children with respiratory tract diseases from January 2006 to December 2015 in Suzhou were collected. FluA was detected by direct immunofluorescence and the FluA detection result was analyzed. Groups were compared with chi-square test.@*Results@#The FluA infection rate was 1.60% in 35 529 children. The FluA infection rate of boys was 1.58%, and the rate of girls was 1.63%. There was no obvious statistically significant difference in sex (χ2=0.139, P=0.709). The FluA infection rates of children at the age of less than 1 year, less than 3 years, less than 7 years and older than 7 years respectively were 1.12%, 2.49%, 1.78%, and 1.24%; there was significant differences among these result (χ2=75.401, P=0.000). The FluA infection rates in spring, summer, autumn and winter respectively were 0.88%, 1.44%, 1.32%, 2.70%. The rates in four seasons had significant difference (χ2=105.432, P=0.000). The FluA infection rate was the highest in winter and the lowest in spring. The FluA infection rate was 6.55% in the autumn of 2008, which was the highest in the recent ten years.@*Conclusions@#FluA is one of the important pathogens of respiratory tract infection in children in Suzhou area. The infection rate of infant is higher and the epidemic peak is in winter. The FluA infection has obvious epidemic season and year. The FluA infection rates in Suzhou area are 0.64%-3.49%, and there was no outbreak in the recent ten years.